normal bone growth physiology

Formation of bone

tissue

·      preosteoblasts differentiate into osteoblasts

·      osteoblasts lay down bone matrix (osteoid)

·      matrix mineralises

·      immature woven bone produced

·      osteoblasts become osteocytes

·      osteoclasts appear and resorb bone

·      mature lamellar bone formed

·      process can occur

·      in cartilage (enchondral)

·      in fibrous tissue (intramembranous)

·      on existing bone (appositional)

structure

·      shape of bone determined by

·      genome and gene expression

·      movement and mechanical forces

·      can be disturbed by extrinsic forces

Intramembranous bone formation

·      mesenchyme forms bone without cartilage anlage

·      occurs in

·      facial bones

·      cranial vault bones

·      pelvic bones

·      part of clavicle

·      part of mandible

·      membrane bones form from mesenchymal condensations

·      condensations are structural analogues of the presumptive bone

·      primary ossification centres form

·      small groups of cells differentiate into osteoblasts and aggregate

·      osteoblasts lay down spicules and islands of bone matrix

·      matrix mineralises

·      osteoblasts cover surface of spicules and islands and add new matrix

·      intramembranous ossification then continues centrifugally

Clavicle

·      clavicle is first foetal bone to undergo membranous ossification

·      ossifies by 8th gestational week

·      intially forms two ossification centres that coalesce into single primary ossification centre

·      develops hyaline cartilage (secondary cartilage) during process

·      forms physis (secondary growth centre) at proximal end

·      is one of last areas to commence secondary ossification and last to undergo epiphyseodesis

Axial and appendicular skeleton

·      also involved in membranous ossification

·      diaphyseal cortex of developing tubular bone derived from perichondrium (periosteum) surrounding cartilaginous model

·      undersurface differentiates into osteoblasts

·      these deposit parallel plates of lamellar bone

Cartilage bone formation

Endochondral ossification

·      mesenchyme forms cartilage anlage which forms bone

·      primary developmental process of skeleton

·      may recur after maturation as fracture repair (maturation of callus)

·      process is continuum that may be arbitrarily divided into phases

Basic anlage

·      condensations occurs in mesenchyme

·      forms precartilagenous basic anlage

·      completed by end of 6th gestational week

Cartilagenous anlage

·      cells differentiate into chondrocytes

·      secrete extracellular ground substance (matrix)

·      forms hyaline cartilage model

·      produces miniature outline of bone to be

·      completed by end of 7th gestational week

Primary collar

·      chondrocytes in centre of anlage hypertrophy

·      increased biochemical activity in the hypertrophic cells leads to calcification of matrix

·      cells in inner layer of perichondrium encircling middle of cartilagenous anlage increase in number

·      cells (osteoblasts) lay down periosteal collar of bone by intramembranous ossification

·      forms primary bone collar

·      comprises multiple rings

·      completed by end of 8th gestational week

Primary ossification centre

·      fibrovascular tissue enters from bone collar into hypertrophic cells at midshaft of anlage

·      bring in osteoblasts and chondroclasts

·      calcified cartilage removed and replaced by bone

·      process extends towards ends of anlage

·      periosteum and bone collar concomitantly extends towards ends of anlage

·      combined process forms primary ossification centre

·      forms diaphysis and metaphyses

Physis

·      orderly arrangement of cells develops adjacent to expanding primary ossification centre

·      forms physis

·      definitive physis forms at end of 3rd / start of 4th gestational month

Medullary cavity

·      central cancellous bone resorbed

·      capillary bud brings in myeloid precursor cells

·      cells proliferate to form marrow

Physis

·      endochondral ossification now limited to physes

·      same process

·      chondrocytes enlarge and become vacuolated

·      matrix calcified

·      invading cells from metaphysis penetrate cartilaginous base and lay down bone on calcified cartilage bars

·      longitudinal growth occurs by continued addition of cartilage at top of plate and continued replacement of calcified cartilage by bone and bottom of plate

·      growth plates move further apart from each other

Secondary centre of ossification

·      secondary centre of ossification develops at different time for different bones

·      called epiphysis

·      chondroepiphyses develop cartilage canals extending inwards from multiple sites in perichondrium

·      these participate in forming secondary ossification centres in chondroepiphysis

·      secondary ossification is primarily a postnatal process

·      distal femoral ossification centre forms just before birth

Components of the growth plate
Cartilaginous component

Reserve zone

·      syn. resting zone, germinal zone

·      lies immediately adjacent to epiphysis

·      sparse single cells

·      separated by large amount of matrix

·      cells store materials for later nutritional requirements

·      lipids, glycogen and proteoglycan aggregates

·      cells do not divide

Proliferative zone

·      flattened cells

·      aligned in longitudinal columns

·      function of cells is

·      matrix production

·      cellular proliferation

·      combination leads to longitudinal growth

·      these are only cells in growth plate to divide

·      top cell is ‘mother’ cell

·      cells accumulate glycogen and calcium

·      rich vascular supply with high oxygen concentration

Hypertrophic zone

·      cells enlarged and spherical

·      as move down zone, cells progressively

·      enlarge

·      consume glycogen

·      release calcium from mitochondria

·      become vacuolated

·      die

·      matrix becomes progressively calcified with formation of hydroxyapatite crystals

·      function of cells is to

·      prepare matrix for calcification

·      calcify matrix

·      zone has poor vascularity and low oxygen tension

·      divided into three subzones

·      zone of maturation

·      zone of degeneration

·      zone of provisional calcification

Metaphysis

·      starts just distal to last intact transverse septum at base of cell column of cartilage portion

·      ends at narrowing of diaphysis

·      there is vascular invasion of hypertrophic zone with laying down of bone by osteoblasts

·      forms primary spongiosa

·      further down, bone laid down on cartilaginous septae removed

·      forms secondary spongiosa

·      further down, original woven bone replaced by lamellar bone

·      called remodelling

·      function of zone is

·      vascular invasion of transverse septa

·      bone formation

·      remodelling

Fibrous peripheral structure

·      growth plate encircled by

·      wedge-shaped groove of cells called the ossification groove or the groove of Ranvier

·      ring of fibrous tissue and bone (periosteal collar) called the ring of LaCroix

·      groove of Ranvier contributes chondrocytes to growth plate for diametric growth

·      ring of LaCroix provides

·      mechanical support for weak bone-cartilage junction of growth plate

·      progenitor cells for periosteum

vascular supply of growth plate
Epiphysis

·      supplied by epipyseal artery

·      branches of artery pass through reserve zone and end in upper part of proliferative zone

Metaphysis

·      supplied by two types of arteries

1.   terminal branches of nutrient artery

·      supply 4/5 of metaphysis

2.   metaphyseal arteries

·      supply peripheral metaphysis

·      terminal branches from both pass vertically to growth plate

·      end in vascular loops just below last intact transverse septum

·      no vessels pass from metaphysis to growth plate

Fibrous component

·      supplied by perichondrial arteries

Growth plate

·      proliferative zone supplied by epiphyseal artery as above

·      no vessels in hypertrophic zone, ie. avascular

Diaphysis

·      increases in diameter by appositional (intramembranous) ossification

Remodelling

·      near birth, bones consist primarily of trabeculae orientated longitudinally and cylindrically

·      trabeculae contain woven bone

·      small marrow cavity

·      near full term, lamellar bone begins to develop

·      cortical thickness and trabecular orientation form according to intraosseous stress patterns (Wolff's law)

·      bone formation increases in areas of compression and decreases in areas of tension

·      compression side is electronegative and osteoblasts stimulated

·      tension side is electropositive and osteoclasts stimulated

Appositional formation

·      occurs during

·      periosteal enlargement of bones

·      bone modelling and remodelling

·      oseoblasts align on existing bone surface

·      cells synthesise osteoid in layers

·      osteoid mineralises